Vulvovaginal symptoms include itching, burning, pain, irritation, dryness, and vaginal odor that can adversely affect women's health. These symptoms may be caused by infections, dermatological and/or hormonal changes, as well as lifestyle habits such as wearing non-breathable clothing. In terms of their consequences, these symptoms can negatively impact women's emotional well-being, quality of life, and sexual function. Their presence can result in changes in social participation and self-confidence, among other aspects.1-3

The prevalence of these symptoms was found to be 51.1% in a study conducted with post-menopausal American women. An impact due to the presence of these symptoms was observed across the other evaluation subscales of the instrument when there was a positive response to the presence of at least one symptom.4 However, data regarding prevalence in Brazilian women and in a younger population remain scarce. These symptoms could be assessed using the Vulvovaginal Symptoms Questionnaire (VSQ) which consists of 21 items divided into four scales: symptoms, emotions, life impact, and sexual impact.1-3

When assessing individuals' health conditions, the International Classification of Functioning, Disability, and Health indicates an interaction between aspects of body structure and function, activity, participation, and contextual factors.4 Contextual factors can be environmental, considering the place of residence (time, territory, and societal interference), and social behavior, which encompasses societal norms and interpersonal relationships. Additionally, personal factors include individual aspects such as age, educational level, lifestyle, and occupation.4-6

These factors can either protect or pose risks to an individual's health, and this applies to women's health as well. Older age, lower educational level, lower socioeconomic status, working outside the home, and having more than two children are predictive factors for health issues in women.7 These factors can affect conditions like urinary incontinence (UI), sexual dysfunction, and menopause, and can influence health habits during pregnancy.7-11

Although studies have examined the effects of these factors on vulvovaginal symptoms, the relationship between contextual factors and vulvovaginal symptoms has not yet been adequately explored in the scientific literature. Therefore, this study aimed to verify the prevalence of vulvovaginal symptoms, their association with contextual factors, and evaluate their impact on the emotional well-being, quality of life, and sexual function of Brazilian women. This information could contribute to structuring prevention and symptom reduction measures, and understanding the role of contextual factors in vulvovaginal symptoms.

Table 2 presents the sample characteristics and bivariate analysis between contextual factors and vulvovaginal symptoms of 313 participants. There were no exclusions based on the criteria of this study. The prevalence of vulvovaginal symptoms in young women was 72.5% (227). The contextual factors of age (p < 0.04), education (p < 0.02), urinary incontinence (p < 0.20), and number of pregnancies (p < 0.03) were included in the multivariate analysis.

The logistic regression model (R2 = 0.032) showed that women with middle or high school levels education and no pregnancy presented a greater association of vulvovaginal symptoms than women with higher educational levels and one or more pregnancies (Table 3).

Vaginal discharge (63.4%) and itching (54.6%) were the most prevalent symptoms (Table 4).

The mean score of VSQ-Br was 5.21 (± 4.5) points. The mean scores of the scales symptoms, emotions, life impact, and sexual impact were 2.6 (± 10.4), 4.0 (± 1.0), 0.6 (± 1.1), and 1.1 (± 1.4), respectively. The sexual impact was analyzed only in sexually active women (179 participants).

The results showed that the prevalence of symptoms among young women was 72.5% (227), low educational levels and no pregnancy were contextual factors associated with vulvovaginal symptoms. Sociodemographic, gynecologic, and obstetric data were similar in both groups. However, participants with vulvovaginal symptoms were older than those without symptoms. The majority of participants reported being physically active, non-smokers, and using contraceptive methods.

The prevalence of vulvovaginal symptoms was high (72.5%) in the participants of this study, and higher than in older populations (51.1%) where investigations of these symptoms are more frequent.2 The instrument used to assess symptoms is an appropriate tool that should be used both in clinical practice and scientific research in Brazil.1-3 However, this assessment may be neglected and forgotten by women due to their lack of knowledge about causes and consequences of vulvovaginal symptoms, as well as by healthcare professionals during patient care.15,16 Given this, the high prevalence of vulvovaginal symptoms in the participants of this study highlights the importance of considering the presence and impacts of symptoms throughout the female life cycle.

Regarding the impact of symptoms assessed by the instrument's subscales, there was no information in the literature about a cutoff point to determine how low or high it would be. In the cross-cultural adaptation and validation study of the instrument, the means found in the emotional impact and quality of life subscale were 0.9 (±1.3) and 0.4 (±0.9), respectively, with no data relating to sexual impact.3 Comparing our findings with the participants evaluated by the instrument adaptation study, we observed that in our study there was a greater reported impact of vulvovaginal symptoms on the participants' lives.

The association between low educational level and prevalent vulvovaginal symptoms may be due to impaired access to health services, low socioeconomic status, and neglect of symptoms. Studies in the United States of America17 and Iran18 analyzing sociodemographic factors in women pre-, peri‑, and post-menopause identified that high educational level, employment, and monthly income influenced the search for health care. Despite the different participant profiles in these studies, we found similar results: vulvovaginal symptoms are less prevalent in women with high education levels, probably due to more search for health care and prevention.

The number of pregnancies was also associated with the prevalence of vulvovaginal symptoms. Health monitoring is important at all stages of the female life cycle, but may be more frequent during pregnancy. In Brazil, health services still face barriers of geographic accessibility, professional availability, and understanding of health care needs.18 These factors are unrelated to female biology, but result in neglect of gynecological health care. Thus, a possible relationship between the findings of this study and data from the literature is that there is a lower frequency than necessary throughout women's lives to health services, with gynecological care only occurring in the presence or worsening of symptoms.19-22 Although the female vital cycle requires routine monitoring, this is uncommon in the general population, being more frequent during the gestational period. Therefore, monitoring during the gestational period can be a source of information about self-care and health care for these women.

Regarding age, participants who presented vulvovaginal symptoms were mainly younger, highlighting the importance of evaluating these symptoms in this population, regardless of their health status. Regardless of life stage, women experience physiological and social changes (e.g., work and family relationships) that affect self-care.23

According to the results of this study, it is relevant to consider the biological aspect (prevalence of symptoms), psychological factors (emotional impact, quality of life, and impact on sexual function), and social aspects (association of contextual factors with the presence of symptoms) in women's health. Based on this knowledge about these data, it becomes possible to have an impact on clinical practice by providing more assertive and meaningful health care to the population. This involves considering their health complaints and specificities, such as personal characteristics and impacts on their social participation, a possible relationship with pelvic floor dysfunctions, among others.

Women's Health physical therapists must perform the physical therapy diagnosis of movement changes related to vulvovaginal symptoms, and there are classification systems for physical therapy diagnoses including the genital system.24 Future studies should investigate not only the impact of vulvovaginal symptoms on women's functionality, but also the specific physical therapy diagnosis in this area that can guide physical therapy treatments.

In this sense, we would like to highlight that, although our sample size corresponds to the one calculated, a larger sample with greater sociocultural and health variability would increase the validity of the study. Furthermore, we recognize that the cross-sectional study design does not allow for the establishing of causality between the variables, and it is important to consider other types of studies to complement our findings. It is also important to note that online data collection may have hindered the participation of elderly women and women in situations of socioeconomic vulnerability. Some variables used, such as physical activity and smoking status, were collected only based on the participants' reports; thus, it is important to perform studies with structured questionnaires. Finally, due to the scarcity of studies on the presence of vulvovaginal symptoms and their relationship with contextual factors, inferences about these aspects become limited.

This study showed a high prevalence of vulvovaginal symptoms in young Brazilian women, and the predominant symptoms were vaginal discharge and itching. Regarding contextual factors, low education and lack of pregnancy were associated with the presence of vulvovaginal symptoms, indicating that these factors can affect female health. Therefore, considering vulvovaginal symptoms in young women and associating them with individual women's characteristics based on contextual factors (such as socioeconomic status and educational level) is important for effective health care delivery.

This work was financed by the São Paulo Research Foundation (FAPESP, grant 318, no. 2019/14666-7).